Headaches Flashcards

1
Q

Red flags for headaches

A
New onset >55 years
Early morning/Wakes you up
Hx of malignancy
Immunosupressed
Exacerbation by Valsalva manouvre
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2
Q

If headache that is worse in the morning (wakes them up) and vomiting then what is it that we are worried about?

A

Tumour

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3
Q

If there is a headache that is increased with coughing/leaning forward that what are we worried about?

A

Congenital problem ass with cerebellum

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4
Q

If headache with flashing lights and one sided what is the most likely diagnosis?

A

Migraine

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5
Q

Headache with tiptoeing, ataxia and vomiting in children. What is the likely differential?

A

Posterior fossa tumour

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6
Q

on average how many attacks will someone with migraines have?

A

1 a month

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7
Q

Who is the classic migraine patient?

A

Young female

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8
Q

Triggers for migraines

A
Stress
Skipping meals
Binge eating
Mensuration/ovulation
OCP
Bright sunshine
Sleep
Physical exertion
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9
Q

What criteria do you need to meet in order to be classified as a migraine without aura?

A

5+ attacks with duration of 4-72h with the following features
Phono/Photophobia
+ 2 of….
Binge eating, Mensturation, Throbbing headache, worse on movement and N&V

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10
Q

How do migraines with aura look different in children?

A

Short lasting
May be bilateral
more prominent gastrointestinal disturbance

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11
Q

Pathophysiology of migraine without aura

A
  • Stress triggers changes in the brain, these changes cause serotonin to be released
  • Blood vessels constrict and dilate
  • Chemicals inc Substance P irritate nerves and blood vessels causing pain
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12
Q

What is an aura?

A

A visible sign of migraine
occur before 20% of migraines
usually last 20-60m
Headaches follow<1h later but can occur simultaneously

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13
Q

Why is the COCP contraindicated in migraines with aura?

A

As migraines with aura increase chance of ischaemic stroke significantly

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14
Q

What is the pathophysiology of migraine with aura?

A

Cortical spreading depolarisation
Activation trigeminal vascular system-dilation cranial blood vessels
Release of substance P, Neurokinin A, CGRP

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15
Q

Acute treatment for migraines

A

Lie in a dark room

Oral triptan and/or NSAID + consider anti-emetic

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16
Q

What are 3 CI to triptans?

A

Coronary vasospasm
IHD
Previous cerebrovascular incidents

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17
Q

When would you use prophylaxis for migraines?

A

If >3 attacks per month OR if severe

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18
Q

What 3 drugs can be used as prophylaxis for migraines?

A

Propanolol
Topiramate
Amitriptyline

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19
Q

What lifestyle modifications can be made in order to reduce the likelihood of migraines?

A
Diet
Hydration
Stress
Avoidance of triggers
Non-pharmacological methods
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20
Q

What is the name when migraines last more than 3 days?

A

Status migrainosus

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21
Q

Classic description of tension type headaches?

A

Band like pressure around the head radiating to the neck

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22
Q

TRUE/FALSE

In tension-type headaches there is absence of N&V and phono/ohotophobia

A

TRUE

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23
Q

Tension-type headaches have a strong association with

A

Depression and anxiety

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24
Q

Most patients who have tension-type headaches self-manage. If it is a chronic refractory type headache then what drug can be used?

A

Amitriptyline

25
Q

Define TAC

A

A group of headache disorders categories by common features of unilateral pain (often severe) in the distribution of the trigeminal nerve.

26
Q

What are the symptoms of TAC?

A

Symptoms on the ipsilateral side

  • ptosis
  • miosis
  • nasal stuffiness
  • N/V
  • Tearing
  • Eyelid oedema
27
Q

What are cluster headaches affectionately known as?

A

Suicide headaches

28
Q

When do cluster headaches occur?

A

Last 10m-3h
occur in bouts (1-8x a day)
for a certain period of the year (few weeks-months)
before ceasing for a long period of time
Occur when going to bed or in the early hours of the morning

29
Q

What is the age of onset and sex distribution of cluster headaches?

A

M>F

Age 20-55

30
Q

What are the 3 characteristic features of cluster headaches?

A
  • Severe unilateral pain
  • Ipsilateral autonomic features
  • Circadian rhythm of onset
31
Q

What investigation is undertaken in all cluster headache patients?

A

MRI and MR angiogram

32
Q

Treatment of Cluster headaches

A

High flow O2 and SC sumitriptan

33
Q

What is the prophylaxis of cluster headaches?

A

Verapamil

34
Q

How are paroxysmal hemicranial different to cluster headaches?

A

They are slightly shorter (10-30m), more often (1-40 times a day), more common in females and have an older age of onset (50-60)

35
Q

What is the Rx for paroxysmal hemicranial?

A

Indomethicin (has complete resolution)

36
Q

What does SUNCT stand for?

A
S-short lived (15-120s) 
U-unilateral 
N-Neuralgiaform headache
C-Conjunctival infections
T-Tearing
37
Q

Treatment of SUNCT

A

Lamotrigine or Gabapentin

38
Q

Compression of CNV by the superior cerebellar artery at the dorsal root entry zone leads to

A

Trigeminal Neuralgia

39
Q

What is another cause of trigeminal neuralgia aside from compression of the nerve?

A

Demyelinating disorder

40
Q

TRUE/FALSE

Trigeminal neuralgia symtpoms tend to be bilateral

A

FALSE

Symptoms tend to be unilateral

41
Q

How would you describe trigeminal neuralgia?

A

Electric shock like pain, usually around nose-mouth
<90s
10-100 a day
Can last weeks-months

42
Q

Incidence of trigemenial neuralgia increases with age TRUE/FALSE

A

TRUE

43
Q

What is trigeminal neuralgia exacerbated by?

A

Touching the area
cold wind
shaving or brushing teeth
talking, eating and drinking

44
Q

Why is MRI an important investigation for trigeminal neuralgia?

A

Use dot exclude compression of the dorsal root entry zone

45
Q

Treatment for trigeminal neuralgia

A

1st line- Carbamazepine

2nd line- Neurosurgical debulking or radio frequency ablation

46
Q

What is the most common cause of secondary headache?

A

Medication overuse syndrome

47
Q

If you have a primary cough headache what might be two underlying causes?

A

Chiari malformation

Aneursym

48
Q

Primary exertion headache is bilateral and pulsating TRUE/FALSE

A

TRUE

49
Q

What are the two subclassifications of primary sexual headache?

A

Early coital cephalgia

Post coital cephalgia

50
Q

What is an early coital cephalgia headache like?

A

Dull, aching, pain in the occipital region

51
Q

When is the most severe headache in post coital cephalgia?

A

During an orgasm

52
Q

What headache is the acute thunderclap headache?

A

Subarachnoid headache

53
Q

What are the two most likely causes for a carotid dissection?

A

1- Spontaneous

2- Due to hyperextension injury of the neck

54
Q

TRUE/FALSE

Giant cell arteritis can present as scalp pain aswell as ischaemic pain in the muscles of mastication

A

TRUE

55
Q

What are the classic RF for IIH

A

Female, Fat, Fertile

56
Q

What is IIH?

A

Idiopathic intracranial hypertension

An idiopathic process, chronically raised CSF pressures within the brain without any discernible SOL to raise ICP

57
Q

What are the symptoms of IIH?

A

Headache
Moderate/gross bilateral papiloedema
N&V
CN VI palsy

58
Q

Is the headache caused by IIH relieved on standing?

A

TRUE

59
Q

What is the treatment for IIH?

A

Wt loss
Acetazolamide
Lumboperitoneal shunt